EBSCO's user research group studies how end users interact with data products via mobile devices, websites, and other interfaces. Insights from clinicians, education professionals, government employees, and others are gathered to help drive data access improvements.

In advance of a major 2015 update to the DynaMed Plus clinical reference resource, EBSCO conducted a qualitative ethnographic study on how physicians search for clinical information. While that may seem like a massive undertaking, it boiled down to following several discrete physician groups in different parts of the country to examine how they searched for clinical information. The project documented what they searched for, on what devices, and at what times.

The hope is that this research will help HIM leaders and chief information officers configure data systems and deploy apps in a more user-friendly fashion. Doing so can make life easier for physicians, which, in turn, will ultimately benefit patient care and health care's bottom line as new efficiencies are discovered.

Four Main Groups of Practitioners
Qualitative and quantitative research studies yield different types of findings. A quantitative method casts a wide net but sometimes can be shallow in detail. On the other hand, qualitative studies focus on a smaller cohort, but can yield deeper insights. Seeking granular detail on physician search habits, EBSCO chose a qualitative strategy. To gain an understanding of what features various interfaces needed, an ethnographic approach was employed to delve deeper into the physician's world.

From the data, the following four physician groups emerged:
• medical students and residents, who've been googling since grade school;
• tech-savvy physicians in their mid-30s who, along with the residents, test apps and influence other physician groups when it comes to selecting clinical data sources;
• hospital-based internist types in their 40s who aren't as tech-savvy but need digital information to help make diagnoses as well as cost-conscious decisions to avoid unnecessary tests and determine generic drug substitutes; and
• veteran academic physicians leading students on rounds and authoring journal articles.

No matter the age group, the study found that physicians—unlike some hospital employees who may have to leave their work behind at the end of the shift—are connected 24/7 to their digital ecosystem. As a result, anyone deploying applications for physicians must survey mobile interfaces as well as Web-facing designs because they will all get workouts at various points in the day.

What We Learned
The survey revealed several interesting points about physician behavior and preferences, including the following:

• Physicians rely heavily on mobile devices at the point of care. As a result, many carry charging cords along with their customary stethoscopes. In addition, they prefer cellular data to hospital Wi-Fi, which may change between floors.

• Medical school, internship, and residency are when most physician habits take shape. Peers and attending physicians are primary influencers as opposed to instructors, librarians, and CIOs.

• Time is tight. Physicians have between two seconds and five minutes to search for information at the point of care. However, they're not looking for analysis during that time. It's often the case that they're 99% certain of their care plan, but are double-checking to confirm their thinking.

• Physicians welcome curated e-mail alerts. While an overflowing inbox is a problem, physicians enjoy subscribing to alerts that help them stay current in their field.

• Physicians search just like us. They use search engines such as Google and Bing to answer questions. If a suitable answer isn't found in the first five results, they revise their search instead of scrolling or clicking through to a second page of results. To support a diagnosis, physicians search by symptom. They also search for drug usage information for medications they're considering prescribing.

• Text isn't necessarily the preferred format. Physicians search images—often Google Images—because some can better illustrate a condition than text and are often the fastest way to convey information. Also popular are how-to videos that demonstrate new procedures and offer opportunities to brush up on familiar ones.

• iPads aren't top of the list. You may figure iPads to be a logical choice to replace both smartphones and laptops, but that isn't the case. The fact that iPads don't fit into lab-coat pockets and present an expanded infection-control risk due to their larger surface area makes them too much of a hassle for many physicians.

• The appetite for apps is growing. Because physicians are typically on smartphones, where screen real estate is at a premium, they need quick lookups. They're not searching from within the EMR on their smartphones either. They need apps, but which ones? The apps preferred by residents and younger, tech-savvy physicians fit the bill. The study found that the influence of these groups trickles up to older physicians and down to interns.

Tips and Takeaways
Based on the survey results, facilities developing custom applications, configuring data interfaces, or creating training modules are advised to keep in mind the following pointers:

• Recruit residents and thirtysomethings as evangelist "superusers." These groups are likely more receptive to the latest technology, and other physicians are apt to follow their lead.

• Make information available in chunks. Some consumer sites now label content as two- or five-minute reads. The physicians surveyed indicated they, too, prefer short, digestible reads, a trend that's been developing across the software industry. Until recently, the focus was on improving page-load time, but that's shifted to decreasing the users' cognitive load.

• Mix the media. Physicians have been force-fed dense text their entire professional careers. The last thing they want to do is read a long research paper on their phones. They yearn for images and videos. Integrate that into content, especially training content.

• Don't skimp on interface design. The quality and appropriateness of a Web design or a software application speaks directly to how credible it will appear to the user. For example, would a savvy consumer input credit card information at a site that looks like it was designed by a ninth-grader? Failure to build a credible platform will negatively impact the implementation's success rate.

• Most importantly, health care organizations must base their implementation decisions on evidence. Whether looking up car reviews, polling pals on social media regarding whether it's time to see a physician for an illness, or helping a child choose a college, it's wise to gather all pertinent evidence before investing time and funds.

The same concept applies to application configuration, content deployments, and training modules. Pull some physicians aside, demo the idea, and gather evidence as to whether it will or won't work, and why. Conduct a small ethnographic study before moving ahead. Demand nothing less than evidence- and data-based information, and hardwire it into the decision-making process.

Laura Klein, a popular blogger in the UX (user experience/interface design) world, has said, "If you skip qualitative research, you're just guessing." EBSCO's research demonstrates how physicians search for clinical information. Add in clinician feedback to make informed HIT purchasing and implementation decisions.

— Kate Lawrence is vice president of user research for EBSCO Information Services. She is a member of the User Experience Professionals Association and an active presenter in the Boston and national UX community.